Provider Demographics
NPI:1114129863
Name:ONTIVEROS, MARIBEL (PT)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:ONTIVEROS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARIBEL
Other - Middle Name:
Other - Last Name:DEVOUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17616 WINDFLOWER WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5318
Mailing Address - Country:US
Mailing Address - Phone:972-679-3261
Mailing Address - Fax:
Practice Address - Street 1:1200 COIT RD
Practice Address - Street 2:SUITE 101A
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-4750
Practice Address - Country:US
Practice Address - Phone:972-964-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1051142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist